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INTRODUCTION: Over the past decade, youth e-cigarette use has risen exponentially. At the same time, digital media use increased markedly while the use of traditional broadcast TV declined. In response, the U.S. Food and Drug Administration's The Real Cost public education campaign shifted to communicating the harms of e-cigarette via primarily digital and social platforms. This study evaluated longitudinal associations between exposure to campaign advertisements and changes in campaign-specific beliefs among US youth. METHODS: A nationally representative longitudinal cohort of youth (aged 11-16 years at baseline) was surveyed five times. Building on earlier work, we analyzed data from the last three waves (April-July 2020; January-April 2021; and August-October 2021; Nâ =â 2625). We assessed self-reported exposure to six ads and agreement with 11 beliefs that were each targeted by one or more ads. Eleven weighted panel regression models assessed whether ad exposure predicted changes in campaign-specific beliefs over time. RESULTS: We observed significant associations between ad exposure and increases in at least one campaign-specific belief for five of the six ads. Across the 11 beliefs, we observed associations between increased exposure and increases in 6 beliefs related to e-cigarettes and toxic metals, lung damage, dangerous ingredients, anxiety, cigarette use, and disappointing important people. CONCLUSIONS: We found evidence that self-reported exposure to this digital and social media campaign was successful at influencing youth, providing support for the effectiveness of the campaign's adaption to address youth's changes in tobacco and media use habits. IMPLICATIONS: The Food and Drug Administration's The Real Cost public education campaign educates youth about the dangers of e-cigarette use. This study evaluates longitudinal associations between exposure to The Real Cost's advertisements and changes in campaign-specific beliefs among youth. Considering evolving trends in youth media consumption, the campaign adapted its media approach to increase delivery across digital and social media platforms. Our findings indicate that the campaign reached its intended audience and increased youth beliefs around the harm of e-cigarettes and the consequences of e-cigarette use, offering evidence for the effectiveness of digital and social media youth prevention efforts within a fragmented digital environment.
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Sistemas Electrónicos de Liberación de Nicotina , Medios de Comunicación Sociales , Adolescente , Humanos , Promoción de la Salud , Internet , Prevención del Hábito de FumarRESUMEN
OBJECTIVE: This study aimed to provide data on extended outcomes in primary clival chordomas, focusing on progression-free survival (PFS) and overall survival (OS). METHODS: A retrospective single-center analysis was conducted on patients with clival chordoma treated between 1987 and 2022 using surgery, stereotactic radiosurgery, or proton radiation therapy (PRT). RESULTS: The study included 100 patients (median age 44 years, 51% male). Surgery was performed using the endoscopic endonasal approach in 71 patients (71%). Gross-total resection (GTR) or near-total resection (NTR) was attained in 39 patients (39%). Postoperatively, new cranial nerve deficits occurred in 7%, CSF leak in 4%, and meningitis in none of the patients. Radiation therapy was performed in 79 patients (79%), with PRT in 50 patients (50%) as the primary treatment. During the median follow-up period of 73 (interquartile range [IQR] 38-132) months, 41 recurrences (41%) and 31 deaths (31%) were confirmed. Patients with GTR/NTR had a median PFS of 41 (IQR 24-70) months. Patients with subtotal resection or biopsy had a median PFS of 38 (IQR 16-97) months. The median PFS of patients who received radiation therapy was 43 (IQR 26-86) months, while that of patients who did not receive radiation therapy was 18 (IQR 5-62) months. The Kaplan-Meier method showed that patients with GTR/NTR (p = 0.007) and those who received radiation therapy (p < 0.001) had longer PFS than their counterparts. The PFS rates following primary treatment at 5, 10, 15, and 20 years were 51%, 25%, 17%, and 7%, respectively. The OS rates at the same intervals were 84%, 60%, 42%, and 34%, respectively. Multivariate Cox regression analysis showed that age < 44 years (p = 0.02), greater extent of resection (EOR; p = 0.03), and radiation therapy (p < 0.001) were associated with lower recurrence rates. Another multivariate analysis showed that age < 44 years (p = 0.01), greater EOR (p = 0.04), and freedom from recurrence (p = 0.02) were associated with lower mortality rates. Regarding pathology data, brachyury was positive in 98%, pan-cytokeratin in 93%, epithelial membrane antigen in 85%, and S100 in 74%. No immunohistochemical markers were associated with recurrence. CONCLUSIONS: In this study, younger age, maximal safe resection, and radiation therapy were important factors for longer PFS in patients with primary clival chordomas. Preventing recurrences played a crucial role in achieving longer OS.
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Cordoma , Fosa Craneal Posterior , Recurrencia Local de Neoplasia , Radiocirugia , Neoplasias de la Base del Cráneo , Humanos , Cordoma/cirugía , Cordoma/radioterapia , Cordoma/mortalidad , Masculino , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Neoplasias de la Base del Cráneo/cirugía , Neoplasias de la Base del Cráneo/radioterapia , Fosa Craneal Posterior/cirugía , Resultado del Tratamiento , Radiocirugia/métodos , Anciano , Supervivencia sin Progresión , Adulto Joven , Estudios de Seguimiento , Procedimientos Neuroquirúrgicos/métodos , AdolescenteRESUMEN
OBJECTIVES: The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents' age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living. METHOD: This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity. RESULTS: A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= -2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity. CONCLUSION: Findings from this study show that pain is a significant factor that is negatively associated with residents' engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.
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PURPOSE: Our institution uses two approaches for nasal mucosal preparation during endoscopic sinus surgery (ESS) to improve surgical field visualization: topical epinephrine (TE) versus topical cocaine with injection of lidocaine containing epinephrine (TCLE). We aimed to compare anesthetic outcomes after ESS using these techniques. METHODS AND MATERIALS: We retrospectively identified adult patients at our institution who underwent ESS from May 2018 through January 2023 under general anesthesia with propofol and remifentanil infusions. Postoperative anesthetic outcomes, including pain and recovery time, were compared between patients who had mucosal preparation with TE versus TCLE using inverse probability of treatment weighting (IPTW) to adjust for potential confounders. RESULTS: Among 1449 patients who underwent ESS, 585 had TE, and 864 had TCLE. Compared with TE, during anesthetic recovery, the TCLE group had fewer episodes of severe pain (numeric pain score ≥ 7) (IPTW-adjusted odds ratio, 0.65; 95 % CI, 0.49-0.85; P = .002), less opioid analgesic administration (IPTW-adjusted odds ratio, 0.55; 95 % CI, 0.44-0.69; P < .001), and shorter recovery room stay (IPTW-adjusted ratio of the geometric mean, 0.90; 95 % CI, 0.85-0.96; P = .002). Postoperative nausea and vomiting and postoperative sedation were similar between groups. CONCLUSIONS: Patients who received preparation of the nasal mucosa with TCLE, compared with TE, were less likely to report severe pain or receive an opioid analgesic in the postanesthesia recovery room and had faster anesthetic recovery. This observation from our large clinical practice indicates that use topical and local anesthetic during endoscopic sinus surgery may have benefit for ambulatory ESS patients.
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The purpose of this manuscript is to describe the protocol for an Alzheimer's Association-funded cluster randomized trial that focuses on engaging assisted living residents with dementia in meaningful activity to help address their behavioral symptoms of distress using a theoretically based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). The development of MAC-4-BSD was based on the Social Ecological Model and Social Cognitive Theory. The MAC-4-BSD intervention includes the following four steps: (1) Assessment of the assisted living physical environment and policies to facilitate meaningful activity; (2) Education of staff about implementation of meaningful activity; (3) Assessment of resident preferences and goals for meaningful activity; (4) Mentoring and motivating staff and residents to facilitate engagement in meaningful activity. The overall aim of this study will be to determine the feasibility and preliminary efficacy of implementing the MAC-4-BSD intervention and test whether it will improve residents' engagement in meaningful activity, behavioral symptoms of distress, and quality of life as well as the environment and policies to promote meaningful activity in assisted living.
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INTRODUCTION: Although nicotine is the main addictive substance in tobacco, tobacco combustion is responsible for most tobacco-related diseases. U.S. adults hold misperceptions about nicotine harm. However, little is known about youth nicotine perceptions. AIMS AND METHODS: To address this gap, we assessed U.S. youths' nicotine perceptions and how these perceptions relate to tobacco use. Participants were youth (ages 12-17) in waves 4 (w4; December 2016-January 2018; N = 14 798) and 4.5 (w4.5; December 2017-December 2018; N = 12 918) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal cohort study. We describe beliefs about nicotine; perceptions of the nicotine harm in cigarettes, e-cigarettes, and nicotine replacement therapy (NRT); and demographic differences. Regressions assess whether w4 nicotine perceptions predicted w4.5 tobacco use. RESULTS: Most youth correctly responded that nicotine is the main cause of addiction (77.1%) but incorrectly responded that nicotine is the main substance that causes smoking-related cancer (74.7%). Youth distinguished between the harm of nicotine in different products, and on average rated the nicotine in cigarettes as most harmful, followed by e-cigarettes and NRT. Among youth who did not use at w4, greater harm perceptions of nicotine in cigarettes, e-cigarettes, and NRT were associated with lower likelihood of reporting current tobacco use at w4.5. Among youth who currently used cigarettes or e-cigarettes at wave 4, nicotine perceptions did not predict switching to e-cigarettes or cigarettes, respectively, at wave 4.5. CONCLUSIONS: These findings underscore the challenge of developing effective and comprehensive communication strategies that accurately convey the effects of nicotine without encouraging tobacco use. IMPLICATIONS: Many U.S. adults have misperceptions about nicotine, incorrectly believing it is the substance that causes most smoking-related cancers; studies have not assessed youth's perceptions of nicotine and how these perceptions relate to tobacco use. This study found that similar to adults, most youth incorrectly believed nicotine is the main substance that causes smoking-related cancer; youth also distinguish between the harmfulness of nicotine in different products, and rated the nicotine in cigarettes as most harmful, followed by e-cigarettes and NRT. Perceptions of the harm in different nicotine and tobacco products negatively predicted becoming a person who used tobacco a year later, but did not predict switching between e-cigarettes and cigarettes. Findings highlight the challenges of accurately communicating about the harms of nicotine without encouraging tobacco use; findings can be considered in the context of FDA's potential nicotine product standard that would lower nicotine levels in combustible tobacco products to a minimally or nonaddictive level.
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Sistemas Electrónicos de Liberación de Nicotina , Neoplasias , Cese del Hábito de Fumar , Productos de Tabaco , Adulto , Adolescente , Humanos , Nicotina/efectos adversos , Estudios Longitudinales , Dispositivos para Dejar de Fumar Tabaco , Productos de Tabaco/efectos adversosRESUMEN
OBJECTIVE: The aim of this study was to compare trajectories of maternal and paternal psychological distress after prenatal diagnosis of fetal moderate-severe congenital heart disease (CHD), from pregnancy through early-mid infancy. METHODS: Pregnant women who received a prenatal diagnosis of fetal moderate-severe CHD, and their partners, were enrolled in a prospective, longitudinal study. Symptoms of psychological distress were measured twice during pregnancy and twice after birth, using the Depression Anxiety Stress Scales (DASS-42). Patterns and predictors of psychological distress were examined using generalized hierarchical linear modeling. RESULTS: Psychological distress was present in 42% (18/43) of mothers and 22% (8/36) of fathers at least once during the study. The rates of distress did not differ between mothers and fathers. There was also no change in probability of distress over time or difference in distress trajectories between mothers and fathers. However, individual trajectories demonstrated considerable variability in symptoms for both mothers and fathers. Predictors of psychological distress included low social support for mothers and a history of mental health conditions for fathers. CONCLUSIONS: Parents who receive a prenatal diagnosis of fetal CHD commonly report symptoms of psychological distress from the time of diagnosis through early-mid infancy and display highly variable trajectories. These data suggest that early and repeated psychological screening is important once a fetal CHD diagnosis is made and that providing mental health and social support to parents may be an important component of their ongoing care.
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Cardiopatías Congénitas , Distrés Psicológico , Masculino , Femenino , Humanos , Embarazo , Estudios Longitudinales , Estudios Prospectivos , Depresión/diagnóstico , Depresión/psicología , Estrés Psicológico/diagnóstico , Estrés Psicológico/psicología , Padre/psicología , Diagnóstico Prenatal , Madres/psicología , Cardiopatías Congénitas/diagnósticoRESUMEN
BACKGROUND: Prophylactic ursodeoxycholic acid (UDCA) may be beneficial in reducing gallstone disease after bariatric surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) 2019 guidelines recommend a 6-month course of UDCA for patients undergoing laparoscopic sleeve gastrectomy (LSG). This has not been adopted broadly. This study intends to assess the effect of routine UDCA administration following LSG on symptomatic gallstone disease. METHODS: We performed a retrospective chart review of patients who underwent LSG, between 2009 and 2019, at two tertiary care centers in Atlantic Canada. At one center, UDCA 250 mg oral twice daily was routinely prescribed following LSG for 6 months to patients with an intact gallbladder. At the other center, UDCA was not prescribed. Primary and secondary outcomes were cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) rates. Compliance with and side effects of UDCA therapy were analyzed. RESULTS: A total of 751 patients were included in the study. Patients who had prior cholecystectomy or were lost to follow up were excluded. After exclusion criteria were applied, 461 patients were included for analysis: 303 in the UDCA group and 158 in the group who did not receive UDCA. Cholecystectomy rate was not significantly associated with UDCA administration, however there was a trend towards less cholecystectomy in patients who received UDCA (8.3% vs. 13.9%, p = 0.056). ERCP rate was significantly lower in patients who received UDCA (0.3% vs 2.5%, p = 0.031). Rate of gallstone disease requiring intervention, either cholecystectomy or ERCP, was significantly decreased in patients who received UDCA (8.9% vs 15.8%, p = 0.022). The most common barriers to compliance with UDCA were cost (45.4%) and nausea (18.1%). CONCLUSION: This is the first study to demonstrate lower rates of ERCP in patients receiving routine UDCA following LSG. Our findings support the ASMBS 2019 guidelines for administering UDCA after LSG for preventing gallstone disease.
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Cálculos Biliares , Gastrectomía , Ácido Ursodesoxicólico , Humanos , Cálculos Biliares/etiología , Cálculos Biliares/prevención & control , Cálculos Biliares/cirugía , Gastrectomía/efectos adversos , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Ácido Ursodesoxicólico/uso terapéuticoRESUMEN
BACKGROUND: Preliminary evidence suggests that providing longer duration prescriptions at discharge may improve long-term adherence to secondary preventative cardiac medications among post-myocardial infarction (MI) patients. We implemented and assessed the effects of two hospital-based interventions-(1) standardized prolonged discharge prescription forms (90-day supply with 3 repeats for recommended cardiac medications) plus education and (2) education only-on long-term cardiac medication adherence among elderly patients post-MI. METHODS: We conducted an interrupted time series study of all post-MI patients aged 65-104 years in Ontario, Canada, discharged from hospital between September 2015 and August 2018 with ≥ 1 dispensation(s) for a statin, beta blocker, angiotensin system inhibitor, and/or secondary antiplatelet within 7 days post-discharge. The standardized prolonged discharge prescription forms plus education and education-only interventions were implemented at 2 (1,414 patients) and 4 (926 patients) non-randomly selected hospitals in September 2017 for 12 months, with all other Ontario hospitals (n = 143; 18,556 patients) comprising an external control group. The primary outcome, long-term cardiac medication adherence, was defined at the patient-level as an average proportion of days covered (over 1-year post-discharge) ≥ 80% across cardiac medication classes dispensed at their index fill. Primary outcome data were aggregated within hospital groups (intervention 1, 2, or control) to monthly proportions and independently analyzed using segmented regression to evaluate intervention effects. A process evaluation was conducted to assess intervention fidelity. RESULTS: At 12 months post-implementation, there was no statistically significant effect on long-term cardiac medication adherence for either intervention-standardized prolonged discharge prescription forms plus education (5.4%; 95% CI - 6.4%, 17.2%) or education only (1.0%; 95% CI - 28.6%, 30.6%)-over and above the counterfactual trend; similarly, no change was observed in the control group (- 0.3%; 95% CI - 3.6%, 3.1%). During the intervention period, only 10.8% of patients in the intervention groups received ≥ 90 days, on average, for cardiac medications at their index fill. CONCLUSIONS: Recognizing intervention fidelity was low at the pharmacy level, and no statistically significant post-implementation differences in adherence were found, the trends in this study-coupled with other published retrospective analyses of administrative data-support further evaluation of this simple intervention to improve long-term adherence to cardiac medications. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03257579 , registered June 16, 2017 Protocol available at: https://pubmed.ncbi.nlm.nih.gov/33146624/ .
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Infarto del Miocardio , Alta del Paciente , Cuidados Posteriores , Anciano , Hospitales , Humanos , Análisis de Series de Tiempo Interrumpido , Cumplimiento de la Medicación , Infarto del Miocardio/tratamiento farmacológico , Ontario , Prescripciones , Estudios RetrospectivosRESUMEN
INTRODUCTION: Tobacco risk perceptions are important predictors of behavior and are impacted by tobacco communications. Our systematic literature review (completed in 2018) found there were no measures of e-cigarette risk perceptions that were completely consistent with tobacco researcher recommendations (eg, specifying use frequency) and had demonstrated validity and reliability. The current study develops measures to assess specific risk perceptions, including absolute risks and risks compared with cigarettes, nicotine replacement therapy, and all nicotine cessation. METHODS AND RESULTS: We generated a list of tobacco health effects based on our previous systematic review of tobacco risk perception measures. Based on health effects prioritized by regulatory science experts, we developed 63 items to assess seven types of e-cigarette risk perceptions: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to all nicotine cessation. We fielded these items in an online survey (N = 1642). Through reliability and validity analyses, we reduced this pool to 21 items, including many single-item measures. Supporting the measures' validity, each measure was negatively associated with current e-cigarette use, e-cigarette intentions, and skepticism about e-cigarette harms; and positively associated with perceiving e-cigarettes as equally or more harmful than cigarettes and intentions to quit e-cigarettes. DISCUSSION: This study developed and validated brief measures of several types of e-cigarette risk perceptions. Surprisingly, we found that for many types of risk perceptions, multi-item measures were redundant and these perceptions were well-represented by single-item measures. IMPLICATIONS: This study developed measures of seven types of e-cigarette health risk perceptions, including absolute health and addiction risk, and risk relative to cigarettes, nicotine replacement therapy, and cessation. We reduced 63 items to 21 to measure all of these constructs. These measures follow tobacco researcher recommendations, were developed using a rigorous measures development process, and demonstrated some aspects of reliability and validity. Because these measures are publicly available, they can be used by public health and industry researchers.
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Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Productos de Tabaco , Humanos , Reproducibilidad de los Resultados , Cese del Hábito de Fumar/métodos , Productos de Tabaco/efectos adversos , Dispositivos para Dejar de Fumar TabacoRESUMEN
INTRODUCTION: Tobacco risk perceptions impact behavior. Our 2018 systematic review of tobacco risk perception measures found no measures of smokeless tobacco (ST) risk perceptions with demonstrated validity and complete consistency with tobacco researcher recommendations (e.g. specifying use frequency). This study develops such measures to assess seven specific risk perceptions of market-leading ST products: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to tobacco cessation. METHODS AND RESULTS: We fielded 64 items assessing risk perceptions associated with tobacco in an online survey experiment (N = 2754) that tested effects of exposing participants to a modified risk claim on a leading ST product. Through reliability and validity analyses, we reduced this to 35 items representing seven constructs. Exploratory factor analyses indicated single-factor solutions for all but two constructs: absolute health risk and health risk relative to cigarettes, which were each represented by two-factors (respiratory and oral risks). Participants perceived respiratory risks differently than oral risks: a modified risk claim reduced ST relative respiratory risk perceptions but increased ST perceived oral risks. CONCLUSIONS: Absolute and relative risk perceptions were each represented by two factors that behaved differently, underscoring the utility of assessing respiratory and oral risk perceptions separately. These measures of seven risk perception constructs demonstrated some validity and can be used to assess perceptions of ST risk in future research, such as postmarket surveillance of tobacco products authorized for marketing by FDA. IMPLICATIONS: This study develops and validates publicly available measures of seven smokeless tobacco risk perception constructs: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to tobacco cessation. This study suggests that for both absolute and relative risk perceptions, risks of respiratory and oral health effects should be assessed separately, because these risk perceptions may be impacted differently by modified risk claims, and are differentially related to smokeless tobacco beliefs, use intentions, and current use.
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Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Productos de Tabaco , Tabaco sin Humo , Humanos , Reproducibilidad de los Resultados , Riesgo , Fumar/epidemiología , Productos de Tabaco/efectos adversos , Dispositivos para Dejar de Fumar Tabaco , Tabaco sin Humo/efectos adversosRESUMEN
PURPOSE: Influencers market products for tobacco companies on social media. This is the first study to systematically examine leading cigar brands' use of influencers on their brand Instagram pages. METHODS: We identified 24 leading cigar brands, using July 2017-June 2018 US retail data. We identified cigar brands that had official appearing Instagram pages, with at least one influencer in the past 20 posts. We coded characteristics of the past three posts from each of five brand pages that contained influencers, such as setting and what the influencer was doing. Finally, we described influencer characteristics. RESULTS: Approximately one-third of the 24 brands had official Instagram accounts with at least one influencer in the past 20 posts. We identified 28 influencers, typically people of colour from the hip-hop music industry, some with millions of followers. Influencers included Bella Thorne (@bellathorne), Shaquille O'Neal (@shaq) and T.I. (@troubleman31). Brands' posts that contained influencers showed the influencer using/holding a product, wearing branded merchandise or appearing in photos with a brand watermark. Three brands' pages posted sponsored event photos (ie, concerts and events using branded backgrounds). DISCUSSION: Cigar brands commonly use influencers to market their products on brand Instagram pages. Results are consistent with previous findings that cigar companies' marketing may target younger African Americans and highlight the potential utility of education campaigns that similarly engage influencers.
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Medios de Comunicación Sociales , Productos de Tabaco , Humanos , Mercadotecnía , Prevalencia , Uso de TabacoRESUMEN
BACKGROUND: Youth and young adults frequently use social media and are susceptible to tobacco use. This study is the first to provide a systematic overview of how leading tobacco product brands use popular social media platforms. METHODS: We identified 112 leading brands of e-cigarettes, hookah, cigars, cigarettes and smokeless tobacco based on sales and self-report user data. We searched for each brand on six platforms: Instagram, Facebook, Twitter, YouTube, Pinterest and Tumblr. In early 2019, we conducted a content analysis of each page, coding: age restrictions, warning display, page characteristics and post characteristics. RESULTS: Cigarette brands were generally not present. Most e-cigarettes, hookah and cigar brands had pages on at least two platforms. One-third of smokeless brands had pages on at least one platform. Few brands had pages on Pinterest and Tumblr. Most pages had existed for 3-5 years. Overall, brand pages rarely used age gating, did not display health warnings, generally posted images of a product alone and often used hashtags unrelated to tobacco. Brands commonly used special features like ephemeral posts on Instagram and pop-up chat windows on Facebook. Many pages displayed images of young people and mentioned flavour. Median followers per brand ranged from about 1 000-10 000, and total followers summed across brands reached over 5 million on Facebook and Instagram alone. CONCLUSIONS: Leading brands of most tobacco product types use social media extensively. Several findings identify issues related to youth exposure to and appeal of tobacco social media marketing. Findings can inform tobacco education efforts and regulation.
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Sistemas Electrónicos de Liberación de Nicotina , Pipas de Agua , Medios de Comunicación Sociales , Productos de Tabaco , Tabaco sin Humo , Adolescente , Humanos , Uso de Tabaco/epidemiologíaRESUMEN
Attrition and reenlistment are critical outcomes that continually shape the Army's workforce. However, relatively little is known about factors that reliably predict which Soldiers will ultimately complete their first term of service or reenlist after their first term has concluded. The present study evaluated the efficacy of a noncognitive measure, the Tailored Adaptive Personality Assessment System (TAPAS), as well as a traditional cognitive test, the Armed Forces Qualification Test (AFQT), as predictors of attrition and reenlistment. Specific categories of attrition were examined based on the reasons Soldiers separated from the Army, both during training and while the Soldiers were in their units. Additionally, analyses were conducted to model attrition over time, and reenlistment was examined both Army-wide and for specific MOS. The paper concludes with a discussion of the findings and needs for future research concerning the potential value of cognitive and noncognitive measures for better understanding and predicting Army attrition and reenlistment.
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BACKGROUND: Food insecurity (FI), limited availability of or access to nutritional foods, is linked to poor child/caregiver health. We examined FI in food-allergic and non-food-allergic children to determine whether dietary limitations associated with food allergy increases risk of FI. METHODS: Food-allergic and non-food-allergic children (1-17 years) were recruited from Arkansas Children's Hospital allergy/asthma clinics. The USDA Food Security Survey, the Newest Vital Sign Health Literacy (HL) questionnaire, and the Food Allergy Impact Scale QOL survey were administered. Logistic regression and analysis of covariance models were utilized for data analysis. RESULTS: Subjects (n = 650) included 325 food-allergic and 325 non-food-allergic children. Overall rate of FI was 21.5% (food allergic 22.2% and non-food allergic 20.9%) with no significant difference in the prevalence of FI between groups (OR = 1.30; 95% CI 0.86-1.96; P = 0.21). FI was increased in households of children with both milk and egg allergy when compared to those without food allergy and those with single food allergy (OR = 2.5; 95% CI 1.4-4.6; P = 0.003). Mean HL rates were higher in the food-secure vs food-insecure groups (mean diff = 0.31; 95% CI 0.03-0.59; P = 0.03). Among food-allergic children, QOL was better in the food-secure vs food-insecure group (mean diff = 0.61; 95% CI 0.002-1.23; P = 0.049). CONCLUSION: Food allergy to milk and egg was associated with increased risk of household FI. Food-insecure participants had lower HL than their food-secure counterparts. Further work is needed to define risks associated with FI among food-allergic children to improve screening and management strategies.
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Hipersensibilidad a los Alimentos/complicaciones , Abastecimiento de Alimentos/estadística & datos numéricos , Alfabetización en Salud/estadística & datos numéricos , Adolescente , Arkansas , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Prevalencia , Calidad de Vida , Factores de Riesgo , Encuestas y Cuestionarios , Atención Terciaria de Salud/estadística & datos numéricosRESUMEN
PURPOSE: Two previous studies indicate that prosmoking apps might encourage smoking behaviour via smoking cues. The current paper seeks to build on these studies and provide an updated overview of the characteristics of tobacco industry-sponsored apps. METHODS: In November 2017, we identified 19 unique top-selling cigarette brands, 20 smokeless tobacco brands, 30 e-cigarette brands and 43 cigar brands based on Nielsen sales from 2016 Nielsen Scantrack data and 2016 Kantar advertising data from the Kantar Media Stradegy database. We searched for these brand-sponsored apps in the Google Play and Apple iTunes US online stores. RESULTS: We identified four cigarette and one smokeless tobacco brand-sponsored apps on the Google Play store, but none in the Apple store. The apps sponsored by Grizzly, Newport, Skoal, Camel and Winston used the last four digits of the users' social security number to verify age. The Marlboro app offered another option in addition to providing a partial social security number-providing a valid home address. The main feature of all apps was location-based, time-sensitive coupons. Some apps had additional functions such as additional detailed product information, interactive help menus and games. DISCUSSION: This paper provides an up-to-date description of apps that are sponsored by tobacco companies. Cessation interventions could consider reminding their target audience to delete these apps to support quit attempts.
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Publicidad Directa al Consumidor , Sistemas Electrónicos de Liberación de Nicotina/economía , Aplicaciones Móviles , Medios de Comunicación Sociales , Industria del Tabaco/métodos , Productos de Tabaco/economía , Tabaco sin Humo/economía , Publicidad Directa al Consumidor/economía , Publicidad Directa al Consumidor/ética , Publicidad Directa al Consumidor/métodos , Humanos , Teléfono Inteligente , Medios de Comunicación Sociales/economía , Medios de Comunicación Sociales/éticaRESUMEN
BACKGROUND: Several jurisdictions in the US and abroad limit the minimum number of cigars that can be sold per package. Research has not evaluated whether small packages might result in cigar use initiation, or whether adding cigars to packages might result in purchasers smoking more cigars. METHODS: Using nationally representative US adult data from Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study, we assessed links between cigar package quantity (number of cigars in the package a person usually buys) and (1) price, and (2) cigar and cigarette use over time, for three cigar types: filtered cigars, cigarillos, and large cigars. RESULTS: Smaller quantity packages (i.e., packages with fewer cigars) were cheaper per-pack than larger quantity packages but more expensive per-stick for all three cigar types. For filtered cigars, past-year starters tended to buy smaller quantity packages compared to longer-term users (geometric mean = 6.31 vs. 11.75, respectively; b = -.18, 95%CI: -.32, -.04). Also, those who bought smaller quantity packages of filtered cigars tended to smoke fewer cigars over time compared to those who bought larger quantity packages (b = 1.16, 95%CI: 0.45, 1.87). Neither of these associations was observed for cigarillos or large cigars. We also found little evidence that buying larger quantity packages predicted continuing to use cigars or using cigarettes. CONCLUSIONS: Although we found consistent associations between package quantity and price, we found few associations between package quantity and changes in cigar smoking behaviors over time, particularly for cigarillos and large cigars. Key limitations include our adult-only analyses and inability to determine the package quantity that cigar users initiated with. Future studies could examine whether package quantity plays a causal role in filtered cigar use initiation or consumption rates.
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Embalaje de Productos/estadística & datos numéricos , Fumar/psicología , Productos de Tabaco , Adulto , Femenino , Humanos , Masculino , Estados UnidosRESUMEN
In order to assess potential interspecific differences in the endocrine mechanisms regulating feeding in Characiformes, we used three fish species with different feeding habits: two Characidae, the omnivore black widow tetra and the carnivore bucktooth tetra, and one Serrasalmidae, the herbivore silver dollar, as models. cDNAs encoding for appetite-regulating peptides (orexin, cocaine and amphetamine regulated transcript CART, cholecystokinin CCK and leptin) were isolated and their tissue distribution examined. The protein sequences of the three species showed most similarities with those of other Characiformes, followed by Cypriniformes and Siluriformes. mRNAs of all four peptides were expressed in the brain. Orexin, CCK and leptin mRNAs were widely distributed in peripheral tissues of all species. CART mRNA displayed a wide peripheral distribution in bucktooth but was predominant in brain in black widow tetra and silver dollar. In order to assess possible interspecific differences in the response to fasting, we compared the expression of these peptides in fed and fasted fish. Fasting induced increases in orexin expression in all species, but decreased brain CART and leptin expressions in silver dollar only. In the intestine, fasting induced a decrease in CCK expression in silver dollar and black widow, and a decrease in leptin expression in bucktooth. Our results suggest that, in Characiformes, different responses of appetite-regulating peptides to fasting are related to both feeding habits and family. The results of this comparative study provide new insights on the regulation of feeding of economically important Characiforme species, which might be valuable for their management and farming.
Asunto(s)
Apetito/genética , Characiformes/fisiología , Ayuno , Conducta Alimentaria , Expresión Génica , AnimalesRESUMEN
Introduction: Tobacco companies have a history of making health claims about their new products. Such claims are now regulated by the US Food and Drug Administration. We examined consumer interest in hypothetical modified risk tobacco products (MRTPs) among current, former, and never established smokers and examined whether interest was associated with beliefs about tobacco and cancer. Methods: Data were analyzed from the US nationally representative 2015 Health Information National Trends Survey (HINTS-FDA 2015; N = 3738). Interest in hypothetical MRTPs was assessed by asking participants their likelihood of using tobacco products claiming to be less addictive and less harmful than other products. Results: About half of current smokers and a tenth of both former and never smokers reported they were "somewhat" or "very" likely to try hypothetical MRTPs claiming to be less harmful or less addictive. Female smokers, former smokers with lower smoking harm perceptions, and never smokers who are young adults or without college education expressed more interest in these products. Interest in using these products was positively associated with believing that smoking status is a changeable individual characteristic and that it is possible for tobacco products to be made without some harmful chemicals. Conclusion: We identified several subgroups of current, former, and never smokers who may be particularly affected by the marketing of MRTPs and therefore important to study to inform models of the potential population health impact of authorizing the marketing of MRTPs. Implications: Findings about interest in hypothetical MRTPs can inform models of how the marketing of MRTPs could affect population health. Understanding which subgroups are particularly interested in MRTPs can help determine who might be important to study to inform these models. We identified several groups who may warrant specific attention: smokers who are female, former smokers who hold low harm perceptions of smoking, never smokers who are young adults or have a high school education or less, people who believe that smoking is a changeable individual characteristic, and people who believe that it is possible to make low chemical tobacco products.
Asunto(s)
Conducta Adictiva/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Productos de Tabaco/normas , Fumar Tabaco/epidemiología , Adolescente , Adulto , Conducta Adictiva/prevención & control , Conducta Adictiva/psicología , Femenino , Humanos , Masculino , Mercadotecnía/métodos , Factores de Riesgo , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Encuestas y Cuestionarios , Productos de Tabaco/efectos adversos , Fumar Tabaco/efectos adversos , Fumar Tabaco/psicología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
SIGNIFICANCE: Most US adults use smartphones for internet access. Understanding what they see when they view smartphone-optimised (mobile) tobacco websites is important, as it can inform tobacco education and cessation strategies. This study describes mobile tobacco websites for leading brands of cigarettes, cigars, smokeless tobacco (smokeless), e-cigarettes and hookah. METHODS: We identified 130 leading tobacco brands based on sales, advertising spending and self-report data. Of these, 62 brands had mobile websites. We conducted an inductive content analysis (ie, where we derived the coding scheme from what we observed) of website characteristics by dual-coding: age requirements, warning display, brand engagement methods (eg, social features) and sales strategies (eg, coupons). RESULTS: All cigarette and most smokeless websites required age-verified accounts for entry, while 76% of e-cigarette websites required accounts only for making purchases. All cigarette and smokeless websites showed warnings, but a minority of e-cigarette and cigar websites did, and no hookah websites did. Many websites required users to scroll up to view warnings. Most e-cigarette websites, most hookah websites, and half of cigar websites linked to multiple social media platforms; however, most cigarette and smokeless websites facilitated socialisation internally. All cigarette, most smokeless and no hookah websites offered coupons. Many cigarette and smokeless coupons were time-sensitive and location-based. CONCLUSIONS: We highlight issues in how tobacco brand websites address youth access, display warnings, engage consumers and facilitate purchase. Results can help public health educators and practitioners better understand tobacco marketing as a context for designing tobacco interventions.